Electrosurgical seal and dissection systems

ABSTRACT

A bipolar electrosurgical fusion/sealer and dissector is provided that is arranged to simultaneously fuse and cut tissue captured between jaws of the instrument. The jaws include particularly positioned, shaped and/or oriented electrodes along with a compressible landing pad to perform the simultaneous fusion and cutting of tissue. An electrosurgical generator is arranged to supply RF energy through the instrument and monitors a phase angle of the supplied RF energy and adjusts or terminates the supplied RF energy based on the monitored phase angle to optimally fuse and dissect the tissue.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/334,102, filed Oct. 25, 2016, which is a continuation ofInternational Application No. PCT/US2015/033546, filed Jun. 1, 2015,which claims the benefit of U.S. Provisional Application No. 62/005,009,filed May 30, 2014, and U.S. Provisional Application No. 62/004,980,filed May 30, 2014, the entire disclosures of which are incorporated byreference as if set forth in full herein.

BACKGROUND

The present application relates generally to electrosurgical systems andmethods and more particularly relates to an electrosurgical fusion/sealand dissection systems.

Electrosurgical devices or instruments have become available that useelectrical energy to perform certain surgical tasks. Typically,electrosurgical instruments are surgical instruments such as graspers,scissors, tweezers, blades, needles that include one or more electrodesthat are configured to be supplied with electrical energy from anelectrosurgical generator. The electrical energy can be used tocoagulate, fuse, or cut tissue to which it is applied.

Electrosurgical instruments typically fall within two classifications:monopolar and bipolar. In monopolar instruments, electrical energy issupplied to one or more electrodes on the instrument with high currentdensity while a separate return electrode is electrically coupled to apatient and is often designed to minimize current density. Monopolarelectrosurgical instruments can be useful in certain procedures, but caninclude a risk of certain types of patient injuries such as electricalburns often at least partially attributable to functioning of the returnelectrode. In bipolar electrosurgical instruments, one or moreelectrodes is electrically coupled to a source of electrical energy of afirst polarity and one or more other electrodes is electrically coupledto a source of electrical energy of a second polarity opposite the firstpolarity. Bipolar electrosurgical instruments, which operate withoutseparate return electrodes, can deliver electrical signals to a focusedtissue area with reduced risks.

Even with the relatively focused surgical effects of bipolarelectrosurgical instruments, however, surgical outcomes are often highlydependent on surgeon skill. For example, thermal tissue damage andnecrosis can occur in instances where electrical energy is delivered fora relatively long duration or where a relatively high-powered electricalsignal is delivered even for a short duration. The rate at which atissue will achieve the desired coagulation or cutting effect upon theapplication of electrical energy varies based on the tissue type and canalso vary based on pressure applied to the tissue by an electrosurgicaldevice. However, it can be difficult for a surgeon to assess how quicklya mass of combined tissue types grasped in an electrosurgical instrumentwill be fused a desirable amount.

SUMMARY

In accordance with various embodiments, an electrosurgical laparoscopicfusion/sealer and dissector instrument is provided that is configured tosimultaneously fuse and cut tissue. In various embodiments, theelectrosurgical device or instrument includes a first jaw and a secondjaw opposing the first jaw to grasp tissue between the first and secondjaws. The first jaw includes an electrode and the second jaw includes anelectrode. The electrodes of the first and second jaws are arranged tofuse and cut tissue between the first and second jaws using radiofrequency energy with center portions of the first and second jawsfacing each other being devoid of an electrode.

In various embodiments, an electrosurgical instrument comprises a firstjaw with a first electrode having a first surface area to contact tissueand a second electrode with a second surface area to contact tissue. Thefirst surface area is the equal to the second surface area. Theinstrument also includes a second jaw opposing the first jaws andcoupled to the first jaw to grasp tissue between the first and secondjaws. The second jaw includes a third electrode having a third surfacearea to contact tissue and a fourth electrode having a fourth surfacearea to contact tissue. The third surface area is equal to the fourthsurface area and the fourth surface area is greater than the firstsurface area. The first and third electrodes are arranged to fuse tissuebetween the first and second jaws using radio frequency energy on oneside of a longitudinal axis and the second and fourth electrodes arearranged to fuse tissue between the first and second jaws using radiofrequency energy on an opposing side of a longitudinal axis.

In accordance with various embodiments, an electrosurgical system forsimultaneously fusing and cutting tissue is provided. The system invarious embodiments comprises an electrosurgical generator and anelectrosurgical fusion/sealer and dissector instrument or device. Thegenerator includes an RF amplifier and a controller. The RF amplifiersupplies RF energy through a removably coupled electrosurgicalinstrument, e.g., an electrosurgical fusion and dissector, configured tofuse and cut tissue with only RF energy. The controller is arranged tomonitor a phase angle of the supplied RF energy, the controllersignaling the RF amplifier to increase voltage of the supplied RF energywhen the monitored phase angle is greater than zero and increasing. Invarious embodiments, the controller signals the RF amplifier to halt thesupplied RF energy when the monitored phase angle decreases.

Many of the attendant features of the present inventions will be morereadily appreciated as the same becomes better understood by referenceto the foregoing and following description and considered in connectionwith the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present inventions may be better understood taken in connection withthe accompanying drawings in which the reference numerals designate likeparts throughout the figures thereof.

FIG. 1 is a perspective view of an electrosurgical system in accordancewith various embodiments of the present invention.

FIG. 2 is a perspective view of an electrosurgical generator inaccordance with various embodiments of the present invention.

FIG. 3 is a perspective view of an electrosurgical instrument inaccordance with various embodiments of the present invention.

FIG. 4 is a perspective view of a distal end of the electrosurgicalinstrument in accordance with various embodiments of the presentinvention.

FIG. 5 is a perspective view of a distal end of the electrosurgicalinstrument in accordance with various embodiments of the presentinvention.

FIG. 6 is a cross-sectional view of a distal end of an electrosurgicalinstrument in accordance with various embodiments of the presentinvention.

FIG. 7 is a cross-sectional view of a distal end of an electrosurgicalinstrument in accordance with various embodiments of the presentinvention.

FIG. 8 is a cross-sectional view of a distal end of an electrosurgicalinstrument in accordance with various embodiments of the presentinvention.

FIG. 9 is a cross-sectional view of a distal end of an electrosurgicalinstrument in accordance with various embodiments of the presentinvention.

FIG. 10 is a cross-sectional view of a distal end of an electrosurgicalinstrument in accordance with various embodiments of the presentinvention.

FIG. 11 is a graphical representation of samples of experimental datafor a fusion and dissection process with an electrosurgical instrumentin accordance with various embodiments of the present invention.

FIG. 12 is a graphical representation of samples of experimental datafor a fusion and dissection process with an electrosurgical instrumentin accordance with various embodiments of the present invention.

FIG. 13 is a graphical representation of samples of experimental datafor a fusion and dissection process with an electrosurgical instrumentin accordance with various embodiments of the present invention.

FIG. 14 is a cross-sectional view of a distal end of an electrosurgicalinstrument in accordance with various embodiments of the presentinvention.

FIG. 15 is a flow chart illustrating operations of an electrosurgicalsystem in accordance with various embodiments of the present invention.

FIG. 16 is a schematic block diagram of portions of an electrosurgicalsystem in accordance with various embodiments of the present invention.

FIG. 17 is a schematic block diagram of portions of an electrosurgicalsystem in accordance with various embodiments of the present invention.

FIG. 18 is a schematic block diagram of portions of an electrosurgicalsystem in accordance with various embodiments of the present invention.

FIG. 19 is a flow chart illustrating operations of an electrosurgicalsystem in accordance with various embodiments of the present invention.

FIG. 20 is a flow chart illustrating operations of an electrosurgicalsystem in accordance with various embodiments of the present invention.

FIG. 21 is a flow chart illustrating operations of an electrosurgicalsystem in accordance with various embodiments of the present invention.

FIG. 22 is a graphical representation of samples of experimental datafor an electrosurgical system in accordance with various embodiments ofthe present invention.

FIG. 23 is a graphical representation of samples of experimental datafor an electrosurgical system in accordance with various embodiments ofthe present invention.

FIG. 24 is a graphical representation of samples of experimental datafor an electrosurgical system in accordance with various embodiments ofthe present invention.

DETAILED DESCRIPTION

Generally, a bipolar electrosurgical fusion/sealer and dissectorinstrument, device or tool is provided that is arranged tosimultaneously fuse and cut tissue captured between jaws of theinstrument. The jaws include particularly positioned, shaped and/ororiented electrodes along with a compressible landing pad to optimallyperform the simultaneous fusion and cutting of tissue. The bipolarelectrosurgical fusion and dissector can also separately fuse or cuttissue. The cutting of tissue in accordance with various embodiments isnotably performed without the use of a mechanical cutting blade, the useof a particular or center cut electrode or the shearing forces ormovement of a scissor. The instrument in accordance with variousembodiments is provided to be used in laparoscopic surgery having amaximum diameter of 5 mm and thus is insertable through a 5 mm trocar.

Additionally, in general, an electrosurgical system is provided thatincludes an electrosurgical generator and a removably coupledelectrosurgical instrument, e.g., a fusion and dissector, that areconfigured to optimally fuse and cut tissue. The RF energy is suppliedby the electrosurgical generator that is arranged to provide theappropriate RF energy to fuse and cut the tissue. The generator inaccordance with various embodiments determines the appropriate RF energyand the appropriate manner to deliver the RF energy for the particularconnected electrosurgical instrument, the particular tissue in contactwith the instrument and/or a particular surgical procedure.Operationally, RF sealing or fusing of tissue between the jaws isprovided to decrease sealing time, output voltage, output power and/orthermal spread. As such, efficiently and consistently delivering powerto tissue is provided to heat tissue through a range of temperatures ata particular rate that has been found to be optimal for the tissueaffect.

Referring to FIGS. 1-2, an exemplary embodiment of electrosurgicalsystem is illustrated including an electrosurgical generator 10 and aremovably connectable electrosurgical instrument 20. The electrosurgicalinstrument 20 can be electrically coupled to the generator via a cabledconnection 30 to a tool or device port 12 on the generator. Theelectrosurgical instrument 20 may include audio, tactile and/or visualindicators to apprise a user of a particular predetermined status of theinstrument such as a start and/or end of a fusion or cut operation. Inother embodiments, the electrosurgical instrument 20 can be reusableand/or connectable to another electrosurgical generator for anothersurgical procedure. In some embodiments, a manual controller such as ahand or foot switch can be connectable to the generator and/orinstrument to allow predetermined selective control of the instrumentsuch as to commence a fusion or cut operation.

In accordance with various embodiments, the electrosurgical generator 10is configured to generate radiofrequency (RF) electrosurgical energy andto receive data or information from the electrosurgical instrument 20electrically coupled to the generator. The generator 10 in oneembodiment outputs RF energy (e.g., 375 VA, 150V, 5 A at 350 kHz) and inone embodiment is configured to calculate a phase angle or differencebetween RF output voltage and RF output current during activation orsupply of RF energy. The generator regulates voltage, current and/orpower and monitors RF energy output (e.g., voltage, current, powerand/or phase). In one embodiment, the generator 10 stops RF energyoutput under predefine conditions such as when a device switch isde-asserted (e.g., fuse button released), a time value is met, and/oractive phase angle and/or change of phase is greater than or equal to aphase and/or change of phase stop value.

The electrosurgical generator 10 comprises two advanced bipolar toolports 12, a standard bipolar tool port 16, and an electrical power port14. In other embodiments, electrosurgical units can comprise differentnumbers of ports. For example, in some embodiments, an electrosurgicalgenerator can comprise more or fewer than two advanced bipolar toolports, more or fewer than the standard bipolar tool port, and more orfewer than the power port. In one embodiment, the electrosurgicalgenerator comprises only two advanced bipolar tool ports.

In accordance with various embodiments, each advanced bipolar tool port12 is configured to be coupled to electrosurgical instrument having anattached or integrated memory module. The standard bipolar tool port 16is configured to receive a non-specialized bipolar electrosurgical toolthat differs from the advanced bipolar electrosurgical instrumentconnectable to the advanced bipolar tool port 12. The electrical powerport 14 is configured to receive or be connected to a direct current(DC) accessory device that differs from the non-specialized bipolarelectrosurgical tool and the advanced electrosurgical instrument. Theelectrical power port 14 is configured to supply direct current voltage.For example, in some embodiments, the power port 14 can provideapproximately 12 Volts DC. The power port 14 can be configured to powera surgical accessory, such as a respirator, pump, light, or anothersurgical accessory. Thus, in addition to replacing electrosurgicalgenerator for standard or non-specialized bipolar tools, theelectrosurgical generator can also replace a surgical accessory powersupply. In some embodiments, replacing presently-existing generators andpower supplies with the electrosurgical generator can reduce the amountof storage space required on storage racks cards or shelves in thenumber of mains power cords required in a surgical workspace.

In one embodiment, connection of a non-specialized bipolar tool into thestandard bipolar port will not cause the generator to actively check thetool. However, the generator recognizes a connection so that theinformation of the non-specialized bipolar tool can be displayed. Inaccordance with various embodiments, the generator recognizes deviceconnection status for each of the advanced tool ports 12 andauthenticates connected devices before accepting RF energy activationrequests (e.g., activation of an instrument switch such as a fusebutton). The generator in one embodiment reads authenticated data fromthe connected device and reads electrical control values (such as butnot limited to voltage level settings, current level settings, powerlevel settings, active phase angle level settings, RF energy outputactivation timing limits, instrument short limits, instrument openlimits, instrument model/identification, RF energy output lineconfigurations, switch state command configurations and/or combinationsthereof) from the authenticated and connected device.

In accordance with various embodiments, the electrosurgical generator 10can comprise a display 15. The display can be configured to indicate thestatus of the electrosurgical system including, among other information,the status of the one or more electrosurgical instruments and/oraccessories, connectors or connections thereto. In some embodiments, thedisplay can comprise a multi-line display capable of presenting text andgraphical information such as for example an LCD panel display, which,in some embodiments can be illuminated via backlight or sidelight. Insome embodiments, the display can comprise a multi-color display thatcan be configured to display information about a particular instrumentelectrically coupled to the electrosurgical generator and a color thatcorresponds to a particular surgical procedure (such as, for examplecutting operations displayed in yellow text and graphics, fusion orwelding operations displayed in purple, and coagulation displayed inblue, bloodless dissection operations can be displayed in yellow andblue).

In some embodiments, the display can be configured to simultaneouslyindicate status data for a plurality of instruments electrically coupledto the electrosurgical generator and/or be portioned to display statusinformation for each instrument connected to a corresponding tool port.A visual indicator such as a status bar graph can be used to illustratea proportion of total available electrical energy to be applied to thebipolar electrosurgical instrument when actuated. In variousembodiments, an electrosurgical instrument operable to cut, seal,coagulate, or fuse tissue could have three color-coded displays or bargraphs. In some embodiments, a user can toggle the display betweenpresenting status of multiple electrically connected instruments andstatus of a single electrically connected instrument. In accordance withvarious embodiments, once an instrument and/or accessory is connectedand/or detected a window opens in the user interface display showing thetype of instrument connected and status.

The electrosurgical generator in accordance with various embodiments cancomprise a user interface such as, for example a plurality of buttons17. The buttons can allow user interaction with the electrosurgicalgenerator such as, for example, requesting an increase or decrease inthe electrical energy supplied to one or more instruments coupled to theelectrosurgical generator. In other embodiments, the display 15 can be atouch screen display thus integrating data display and user interfacefunctionalities. In accordance with various embodiments, through theuser interface, the surgeon can set a voltage setting by the selectionof one to three levels. For example, at level 1, voltage is set to 110V;at level 2, voltage is set to 100V; and at level 3, voltage is set to90V. Current is set to 5 Amps and power is set to 300 VA for all threelevels. In other embodiments, the voltage is preset or defaults to aspecific level such as level 2. In other embodiments, like the currentand power settings, the voltage setting is not user adjustable tosimplify operation of the generator and as such a predetermined defaultvoltage setting is utilized, e.g., voltage is set to 100V.

In one embodiment, the electrosurgical tool or instrument 20 can furthercomprise of one or more memory modules. In some embodiments, the memorycomprises operational data concerning the instrument and/or otherinstruments. For example, in some embodiments, the operational data mayinclude information regarding electrode configuration/reconfiguration,the instrument uses, operational time, voltage, power, phase and/orcurrent settings, and/or particular operational states, conditions,scripts, processes or procedures. In one embodiment, the generatorinitiate reads and/or writes to the memory module.

In one embodiment, each advanced bipolar electrosurgical instrumentcomes with a memory module and/or an integrated circuit that providesinstrument authentication, configuration, expiration, and logging.Connection of such instruments into the receptacles or ports initiatesan instrument verification and identification process. Instrumentauthentication in one embodiment is provided via a challenge-responsescheme and/or a stored secret key also shared by the generator. Otherparameters have hash keys for integrity checks. Usages are logged to thegenerator and/or to the instrument integrated circuit and/or memory.Errors in one embodiment can result in unlogged usage. In oneembodiment, the log record is set in binary and interpreted with offlineinstruments or via the generator.

In one embodiment, the generator uses time measurement components tomonitor an instrument's expiration. Such components utilize pollingoscillators or timers or real-time calendar clocks that are configuredat boot time. Timer interrupts are handled by the generator and can beused by scripts for timeout events. Logging also utilizes timers orcounters to timestamp logged events.

In accordance with various embodiments, the generator provides thecapability to read the phase difference between the voltage and currentof the RF energy sent through the connected electrosurgical instrumentwhile RF energy is active. While tissue is being fused, phase readingsare used to detect different states during the fuse or seal and cutprocess.

In one embodiment, the generator logs usage details in an internal logthat is down loadable. The generator has memory for storage of code andmachine performance. The generator has reprogrammable memory thatcontains instructions for specific instrument performance. The memoryfor example retains a serial number and instrument use parameters. Thegenerator stores information on the type of instruments connected. Suchinformation includes but is not limited to an instrument identifier,e.g., a serial number of a connected instrument, along with a timestamp, number of uses or duration of use of the connected instrument,power setting of each and changes made to the default setting. Thememory in one embodiment holds data for about two months, about 10,000instrument uses or up to 150 logged activations and is configured tooverwrite itself as needed.

The generator in accordance with various embodiments does not monitor orcontrol current, power or impedance. The generator regulates voltage andcan adjust voltage. Electrosurgical power delivered is a function ofapplied voltage, current and tissue impedance. The generator through theregulation of voltage can affect the electrosurgical power beingdelivered. However, by increasing or decreasing voltage, deliveredelectrosurgical power does not necessarily increase or decrease. Powerreactions are caused by the power interacting with the tissue or thestate of the tissue without any control by a generator other than by thegenerator supplying power.

The generator once it starts to deliver electrosurgical power does socontinuously, e.g., every 150 ms, until a fault occurs or a specificphase parameter is reached. In one example, the jaws of theelectrosurgical instrument can be opened and thus compression relievedat any time before, during and after the application of electrosurgicalpower. The generator in one embodiment also does not pause or wait aparticular duration or a predetermined time delay to commencetermination of the electrosurgical energy.

With reference to FIGS. 3-14, in accordance with various embodiments, anbipolar fusion and dissector electrosurgical instrument 20 is provided.In the illustrated embodiment, the instrument 20 includes an actuator 24coupled to an elongate rotatable shaft 26. The elongate shaft 26 has aproximal end and a distal end defining a central longitudinal axistherebetween. At the distal end of the shaft 26 are jaws 22 and at theproximal end is the actuator. In one embodiment, the actuator is apistol-grip like handle. The shaft 26 and jaws 22, in one embodiment,are sized and shaped to fit through a 5 mm diameter trocar cannula oraccess port.

The actuator 24 includes a movable handle 23 and a stationary handle orhousing 28 with the movable handle 23 coupled and movable relative tothe stationary housing. In accordance with various embodiments, themovable handle 23 is slidably and pivotally coupled to the stationaryhousing. In operation, the movable handle 23 is manipulated by a user,e.g., a surgeon to actuate the jaws, for example, selectively openingand closing the jaws. In accordance with various embodiments, theactuator 24 includes a force regulation mechanism that is configuredsuch that in a closed configuration, the jaws 22 delivers a grippingforce between a predetermined minimum force and a predetermined maximumforce.

As part of the force regulation mechanism, the movable handle 23 iscoupled to the stationary handle at two sliding pivot locations to formthe force regulation mechanism. The movable handle has a first endincluding a gripping surface formed thereon and a second end oppositethe first end. The movable handle is coupled to a pin adjacent thesecond end. In some embodiments, the movable handle can be integrallyformed with a protrusion extending therefrom defining a pin surface,while in other embodiments, a pin can be press-fit into an aperture inthe movable handle. The pin can be contained within slots in thestationary housing, such as a corresponding slot formed in a rightand/or left handle frames of the stationary housing. In someembodiments, the slots can be configured to define a desired actuationhandle path, such as a curved or angled path, as the actuation handle ismoved from the first position corresponding to open jaws to a secondposition corresponding to closed jaws. The force regulation mechanismincludes a biasing member such as a tension spring that biases the pinin a proximal direction. In operation, as a predetermined force isexerted on by movement of the movable handle, a biasing force exerted bythe spring is overcome, and the second end of the movable handle cantranslate generally distally, guided by the pin in the slots.

In accordance with various embodiments, the movable handle is slidablyand pivotably coupled to the stationary housing 28 at a location betweenthe first and second ends of the actuation handle. An actuation membersuch as a pull block is coupled to the actuation handle. When themovable handle is moved proximally, the pull block also moves proximallyand longitudinally, closing the jaws 22 thereby clamping any tissuebetween the jaws. The pull block in accordance with various embodimentsis rectangular having open top and bottom faces and a closed proximalend. The movable handle extends through the top and bottom faces of thepull block. An edge of the movable handle bears on the proximal end ofthe pull block such that movement of the movable handle relative to thestationary housing moves the pull block longitudinally. A distal end ofthe pull block in one embodiment is coupled to an actuation shaft suchas a pull tube, bar, or rod, which can extend longitudinally along theelongate shaft 26. Thus, in operation, movement of the movable handlefrom the first position to the second position translates the pull blocklongitudinally within the stationary housing, which correspondinglytranslates the pull tube generally linearly along the longitudinal axiswith respect to the elongate shaft 26. Movement of this pull tube cancontrol relative movement of the jaws 22.

In accordance with various embodiments, the actuator 24 includes a latchmechanism to maintain the movable handle 23 in a second position withrespect to the stationary housing 28. In various embodiments, themovable handle comprises a latch arm which engages a matching latchcontained within stationary handle for holding the movable handle at asecond or closed position. The actuator in various embodiments alsocomprises a wire harness that includes insulated individual electricalwires or leads contained within a single sheath. The wire harness canexit the stationary housing at a lower surface thereof and form part ofthe cabled connection. The wires within the harness can provideelectrical communication between the instrument and the electrosurgicalgenerator and/or accessories thereof.

In accordance with various embodiments, the actuator includes one ormore leads attached to rotational coupling clips configured to allowinfinite rotation of the shaft. In various embodiments, a switch isconnected to a user manipulated activation button 29 and is activatedwhen the activation button is depressed. In one aspect, once activated,the switch completes a circuit by electrically coupling at least twoleads together. As such, an electrical path is then established from anelectrosurgical generator to the actuator to supply RF energy to theleads attached to the rotational coupling clips.

In one embodiment, the actuator includes a rotation shaft assemblyincluding a rotation knob 27 which is disposed on an outer cover tube ofthe elongate shaft 26. The rotation knob allows a surgeon to rotate theshaft of the device while gripping the actuator 24. In accordance withvarious embodiments, the elongate shaft 26 comprises an actuation tubecoupling the jaws 22 with the actuator. In various embodiments, theactuation tube is housed within an outer cover tube. While the actuationtube is illustrated as a generally tubular member that can be nestedwithin the outer cover tube, in other embodiments, a non-tubularactuation member can be used, for example, a shaft, a rigid band, or alink, which, in certain embodiments can be positioned within the outercover tube.

In accordance with various embodiments, attached to the distal end ofthe outer cover tube is the rotational shaft assembly comprising twomating hubs and a conductive sleeve. The hubs snap together, engagingwith the outer cover tube. In other embodiments, the hubs can be of amonolithic construction and configured to interface with mating featureson the outer cover tube. The conductive sleeve can be attached to theproximal portion of the assembled hubs after they are attached to theouter cover tube. When the conductive sleeve is attached to the rear ofthe assembled hubs, the sleeve traps the exposed end of an isolatedwire. In the illustrated embodiment, the isolated wire extends from itsentrapment point under the conductive sleeve through a slot in theactuation tube and then inside a protective sleeve. The protectivesleeve and isolated wire extend distally inside the actuation tube,towards the jaws. In other embodiments, the isolated wire can be formedintegrally with a protective sheath and no separate protective sleeve ispresent in the actuation tube.

Attached to the distal end of the elongate shaft are jaws 22 thatcomprise a first jaw 70 and a second jaw 80. In one embodiment, a jawpivot pin pivotally couples the first and second jaws and allows thefirst jaw to be movable and pivot relative to the second jaw. In variousembodiments, one jaw is fixed with respect to the elongate shaft suchthat the opposing jaw pivots with respect to the fixed jaw between anopen and a closed position. In other embodiments, both jaws can bepivotally coupled to the elongate shaft such that both jaws can pivotwith respect to each other.

The jaw geometry provides for specific pressure profiles and specificcurrent densities in specific locations to produce the requiredfusion/seal and dissection effect. Operationally, the temperaturerequired to achieve sealing and division is minimized while the crosslinking of proteins within the vascular structure are maximized therebymaximizing the efficacy of the fuse/seal and division of tissue.

In accordance with various embodiments, in order to monitor thetemperature of the biological reaction, phase angle and/or the rate ofchange of the phase angle is monitored. It has been found that the phaseangle provides indicators of the temperature of the biological reactionand an indication that the division of the tissue has occurred. Inaccordance with various embodiments, the device uses bipolar RF energyfor electrosurgery for cutting and fusing of tissue between the jawswhen opened or closed and/or in contact with the lower jaw when the jawsare open or closed. In one embodiment, temperature of the tissue duringthe seal and/or division cycle is monitored.

The advanced bipolar electrosurgical device in accordance with variousembodiments uses bipolar RF energy for both the sealing or fusing andthe division or cutting of tissue. As such, the device maintainscellular structure of tissue adjacent to the area of division whileapplying the energy required for the division of tissue. Other RFdissection devices use localized arcing or a spark gap to vaporizetissue and achieve dissection. This may be acceptable for straighttissue dissection because the surrounding area is not also intended tobe sealed or fused, but is unlike the fusion and dissector devices andsystems in accordance with various embodiments of the present invention.

The advanced bipolar electrosurgical device in accordance with variousembodiments also accounts for the high heat associated with thevaporization of tissue or tissue dissection. As such, the device invarious embodiments uses temperature control to minimize the energyrequired to achieve tissue division. By minimizing the energy required,the temperature during the reaction is lower and the cellular structureis less likely to be disrupted due to high energy output.

Maintaining the cellular structure of the operating tissue is neededwhen simultaneously fusing and dissecting or dividing because it isnecessary for sealing to occur adjacent to the area of division. Theaddition of open cut and seal mode also reduces the number of devices orthe exchange of devices used in performance of a surgical procedure assuch or all such functionality of such individual devices are providedin the single advanced bipolar laparoscopic device.

In various embodiments, the electrosurgical instrument comprises movablejaws able to capture tissue therebetween. In one embodiment, the jawsinclude one upper jaw that closes onto a static lower jaw. In accordancewith various embodiments, the upper jaw includes a rigid upper jawmember 41, an upper conductive pad 42, a rigid insulating pad 43, a wire44, and a compressible landing pad 45 which are all bound together usingan insert molding process and thus is provided as a single structure orassembly as shown in the FIG. 6.

The rigid upper jaw member and the upper conductive pad are both activeelectrodes which have opposite polarities. The compressible landing padprovides a surface with a specific spring rate to ensure that contactand pressure occurs between the landing pad and the length of the lowerjaw. The upper conductive pad 42 is electrically isolated from the rigidupper jaw member 41 by the landing pad 45 and the insulating pad 43. Invarious embodiments, the upper jaw is made of stainless steel and ismore rigid than the landing pad 45. In various embodiments, the landingpad 45 is made of silicone and is more compliant than the upper jawmember 41 or conductive pad 42. In various embodiments, the insulatingpad is made of a non-conductive material and is as rigid as or morerigid than the upper jaw member 41 or the conductive pad 42. In variousembodiments, the upper jaw member 41 and the conductive pad are made ofthe same material.

The upper jaw member 41 and the conductive pad have a lower outersurface arranged to be in contact with tissue. The lower surfaces areangled or sloped and mirror images of each other with such positioningor orientation facilitating focused current densities and securement oftissue. The compressible landing pad 45 has a lower surface arranged tobe in contact with tissue and/or the lower jaw. The landing pad in theillustrated embodiment is flat and non-parallel relative to the slopedlower surfaces of upper jaw member and the conductive pad 42. Thepositioning or orientation of the lower surface of the landing padassists in focusing current densities, securing of tissue andfacilitating electrically dissecting of tissue. The spring rate of thelanding pad in various embodiments is predetermined to provide optimalpressure or force to cause or facilitate the electrical division oftissue.

The lower jaw comprises a rigid lower jaw member 52, a lower conductivepad 53, a cut electrode 55, two rigid insulators 54, 56, as well as twowires, one to the conductive pad and one to the cut electrode, all ofwhich is bound together using an insert molding process and thus areprovided as a single structure or assembly as shown in FIG. 7 inaccordance with various embodiments of the present invention. The rigidlower jaw member 52, the lower conductive pad 53, and the cut electrode55 are all or act as active electrodes. The lower conductive pad 53 andthe cut electrode 55 have the same polarity and are electricallyisolated by the two rigid insulators 54 and 56 from the rigid lower jawmember which has the opposite polarity.

The lower jaw member 52 and the conductive pad 53 have an upper outersurface arranged to be in contact with tissue. The upper surfaces areangled or sloped and mirror images of each other with such positioningor orientation facilitating focused current densities and securement oftissue. In various embodiments, the lower jaw is made of stainless steeland is as rigid as or more rigid than the conductive pad 53. In variousembodiments, the rigid insulators 54, 56 are made of a non-conductivematerial and are as rigid as or more rigid than the lower jaw member 52or the conductive pad 53. In various embodiments, the lower jaw member52 and the conductive pad 53 are made of the same material.

The overall jaw configuration in accordance with various embodiments isshown in cross-section in FIG. 8 and demonstrates the interaction of thegeometries (e.g., shape, dimension, material and any combination thereoffor optimal fusion and dissection) between the upper jaw and the lowerjaw. In operation, the conductive pads 42, 53 are of the same polarity.The upper and lower jaw members 41, 51, 52 are the same polarity, butthe opposite polarity of the conductive pads 42, 53. In one embodiment,the cut electrode 55 is only active during an open cut and fuseoperation and is the opposite polarity of the lower jaw member 52. Asillustrated, the landing pad 45 interferes and compresses onto the lowerjaw member 52 and conductive pad 53 upon closure of the jaws. Tissue(not shown) also captured between the lower jaw and the upper jaw iscompressed between the landing pad 45 and the lower jaw member 52 andthe conductive pad 53.

The polarity of each electrode is set to create the appropriate RFenergy and heating due to electrical current passing therebetween. Asshown in FIG. 9, the direction of current flow allows for heatingbetween the conductive pads and the jaw members, as well as creatingheating from side to side on the lower jaw configuration, as exemplifiedby arrows 101. The side to side heating on the lower jaw configurationis provided for the division of tissue, as exemplified by arrow 102. Inorder to divide the tissue down the middle of the jaw, the tissue isheated to reach a temperature between 60° C. and 100° C. to denature thecollagen present in the tissue. Once the collagen has been denatured, itenters into a gelatin like state.

As the tissue is gelatinous or in a gelatin like state, the spring rateand the interference of the silicone landing pad causes mechanicalseparation of the tissue as exemplified in FIG. 10 and arrow 103. Invarious embodiments, the spring rate is predetermined to optimize theseparation of the tissue by the interference with the pad and the lowerjaw such that the landing pad compresses a predetermined distance oramount in conformance with the tissue there between and with minimal orno effects to the adjacent tissue. Therefore, the configuration of theelectrodes allow for simultaneous heating of the seal area (the areabetween the conductive pads and the jaw members) and the cut area (theside to side current region on the lower jaw). The denaturing of thecollagen is also the mechanism used to create a tissue seal or fuse.Sealing utilizes the same temperature (60° C. to 100° C.) as cutting,but the jaw seal spacing between the conductive pads and the jaw memberscreates a form or mold for the seal to re-cross-link once the RFapplication ceases. It is noted that reaching high temperatures rapidlycan cause the cellular structure to rupture due to the rapid heating ofintercellular moisture. Therefore, a gradual increase of temperature anda longer dwell time in the appropriate temperature range allows for morethorough denaturing of the collagen.

In various embodiments, in order to achieve the appropriate temperatureof the tissue to cause the associated tissue effect, e.g., a gradualincrease and/or longer dwell time, the phase angle of the tissue and/orthe rate of change of the phase angle are monitored. FIGS. 11-13 providea graphical representation of exemplary seal and division cycles inaccordance with various embodiments. Also, as illustrated, phase 111 gis shown relative to other tissue readings or indicators such as voltage111 a, power 111 b, impedance 111 c, energy 111 d, temperature 111 e andcurrent 111 f. Additionally, although shown in FIGS. 11-13, in variousembodiments, the generator is configured to not measure or calculate oneor more of the indicators or readings, e.g., temperature or energy, toreduce operational and power costs and consumptions and/or the number ofparts of the generator. The additional information or readings aregenerally provided or shown for context purposes.

As shown in FIGS. 11-13, the temperature of the tissue 111 e between thejaws increases from the initiation of RF energy to a point of thehighest phase angle. At this point of the highest phase angle (or thepoint of inflection of the rate of change of phase angle) 155 thetemperature plateaus 150 momentarily (˜0.75 seconds), then continueshigher 152, even though voltage decreases.

Due to the behavior of the temperature profile, it is noted that themomentary plateau in temperature may be attributed to the change instate of the water or moisture present in the tissue. When the waterbegins to boil, the temperature does not increase until the liquid waterhas been turned to water vapor. The determination of the temperature 111e as such can be based off the phase angle 111 g. The temperature priorto the maximum phase angle is associated with a steady heating to 100°C. The plateau in temperature is associated with a sudden decrease inthe phase angle which can be associated with 100° C. and two-statewater. Because liquid water is highly conductive and water vapor is not,this transition in phase may be another indicator of the water's state.Once the temperature continues to increase past 100° C. (152) and past asecond point of phase angle inflection 160, it can be noted that themajority of the water has been turned to water vapor.

Another point of interest that can be seen in the RF output is thesudden spike 170 in power 111 b and current 111 f during the boiling ofwater portion of the RF application as shown for example in FIG. 13. Thespike can be attributed to the division of the tissue during the sealingor fusing process. This increase in power and current can be due totissue being no longer present under the insulated portion of the jaws,e.g., the landing pad. At this point, the jaw closes more, and theenergy transfer is only through the seal surfaces.

Since the temperature required to denature the collagen begins at 60°C., the energy application is optimized to maximize the time prior to100° C. This provides for a complete and thorough denaturing of thecollagen. As such, all sealing should be completed prior to the spike170 in power and current such that sealing is completed prior todivision.

In accordance with various embodiments, the electrosurgical instrumentalso has the ability to cut tissue using RF energy and in one embodimentonly with the jaws in a fully open position, only utilizing the lowerjaw, without cooperation of the upper jaw or tissue not captured betweenthe upper and lower jaws but in contact with the lower jaw. FIG. 14shows the direction of current flow, arrow 140, from the cut electrode55 to the rigid lower jaw member 52.

To achieve tissue cutting, a high voltage potential is created betweenthe cut electrode 55 and the lower jaw member 52. This provides for thevaporization of tissue due to the heat created by local arcing aroundthe cut electrode. As high temperature is encountered, the insulatingmaterial used to isolate the cut electrode in one embodiment withstandsor operates well at high temperatures. Also, with the high voltagepotential, the insulator in one embodiment has a high dielectricstrength. The voltage potential is greater than 400 V-peak in order toachieve sufficient arcing. The actual potential however is directlyrelated to the spacing between the cut electrode and the lower jawmember.

Arc suppression is another concern and as such quick rectification of RFwaveform distortion due to arcing and/or limiting power output toprevent the degradation of the materials used in the construction of thejaw are provided. If an arc is allowed to persist for more than 100micro seconds, there is an increased risk of device degradation. Also,due to the extreme heat associated with the localized arcing, RF energyapplication in accordance with various embodiments includes apredetermined duty cycle or a waveform with a high crest factor. It hasbeen found that the crest factor associated with a sinusoidal waveformdoes not allow for a constant output without causing degradation to thedevice. Manipulation of the duty cycle or crest factor brings theaverage output power down over the entire activation of the device.

The electrosurgical instrument in accordance with various embodimentsalso fuses tissue using RF energy and in one embodiment only with thejaws in a fully open position, only utilizing the lower jaw, withoutcooperation of the upper jaw or tissue not captured between the upperand lower jaws but in contact with the lower jaw. FIG. 14 exemplarilyillustrates a direction of current flow from the cut electrode 55 to therigid lower jaw member 52.

In accordance with various embodiments, to cause tissue coagulation, alow voltage potential is maintained between the cut electrode 55 and thelower jaw member 52. The voltage potential is set to be lower than 100V-peak in order to prevent localized arcing, but the actual potential isdirectly related to the spacing between the cut electrode and the lowerjaw member. Tissue coagulation is caused by heat generated by the RFcurrent between the two electrodes.

In one embodiment, the isolated wire 44 is routed to electrically couplethe first jaw to the wiring harness in the actuator. The isolated wireextends from the distal end of the protective sleeve which is housed atthe proximal end of the second jaw and extends into the first jaw. Thefirst jaw can have a slot positioned to receive the isolated wire. Theisolated wire then extends through a hole in the first jaw and dropsinto a slot in a nonconductive portion. The isolated wire then extendsto the distal end of the nonconductive portion and drops through to theconductive pad.

In some embodiments, electrode geometry of or on the conductive pads ofthe jaws ensures that the sealing area completely encloses the distalportion of the cutting path. In accordance with various embodiments, thedimensions of the jaw surfaces are such that it is appropriatelyproportioned with regards to the optimal pressure applied to the tissuebetween the jaws for the potential force the force mechanism can create.Its surface area is also electrically significant with regards to thesurface area contacting the tissue. This proportion of the surface areaand the thickness of the tissue have been optimized with respect to itsrelationship to the electrical relative properties of the tissue.

In one embodiment, as illustrated in FIG. 15, an electrosurgical processsuch as a tissue fusion and/or cut process starts with depressing aswitch on the tool (151), which starts an initial measurement sequence.With engagement of a switch on the tool, the generator takes initialmeasurements on the tissue (opens, shorts, etc.) (152) and based on theinitial measurements initiates or does not initiate the supply of RFenergy (153). In accordance with various embodiments, the generatormeasures tool and/or tissue impedance and/or resistance, and/or if aphase angle is within an acceptable range. In one embodiment, thegenerator performs a passive measurement of tissue between theelectrodes of an electrosurgical tool connected to the generatorutilizing RF energy with a low energy range (e.g., a voltage about 1-10Volts) that does not cause a physiological effect. In variousembodiments, the generator uses the initial impedance measurement todetermine if the tool is shorted, faulty, open and the like. Based on apositive result of the initial check, the generator for exampleswitches-in a supply of RF energy from the generator to theelectrosurgical tool and ultimately to the tissue (154). After RF poweris turned on and is being supplied continuously by the generator, thegenerator monitors the phase angle or difference and/or change of phaseangle between current and voltage of the supplied RF energy (155).

At or upon a predefined or predetermined point, condition or threshold(156), the supply of RF energy is terminated (157). In this case, anacoustical and/or visual signal is provided indicating that the tissueis fused (or that an error has occurred (e.g., shorting of theelectrodes) and/or an unexpected condition has occurred (e.g.,permissible although unexpected switch release)). In accordance withvarious embodiments, the predefined point, condition or threshold and/orinitialization checks are determined based on a tool algorithm or scriptprovided for a connected electrosurgical tool, procedure or preference.In accordance with various embodiments, the product of measured tissuepermittivity and conductivity or an initial phase shift is utilized todetermine the end point for a connected tool.

Referring now to FIG. 16, in one embodiment, the electrosurgicalgenerator 10 is connected to AC main input and a power supply 141converts the AC voltage from the AC main input to DC voltages forpowering various circuitry of the generator. The power supply alsosupplies DC voltage to an RF amplifier 142 that generates RF energy. Inone embodiment, the RF amplifier 142 converts 100 VDC from the powersupply to a sinusoidal waveform with a frequency of 350 kHz which isdelivered through a connected electrosurgical instrument. RF sensecircuitry 143 measures/calculates voltage, current, power and phase atthe output of the generator in which RF energy is supplied to aconnected electrosurgical instrument 20. The measured/calculatedinformation is supplied to a controller 144.

In one embodiment, the RF sense analyzes the measured AC voltage andcurrent from the RF amplifier and generates DC signals for controlsignals including voltage, current, power, and phase that are sent tothe controller for further processing. In one embodiment, RF sense 143measures the output voltage and current and calculates the root meanssquare (RMS) of the voltage and current, apparent power of the RF outputenergy and the phase angle between the voltage and current of the RFenergy being supplied through a connected electrosurgical instrument. Inparticular, the voltage and current of the output RF energy areprocessed by analog circuitry of the RF sense to generate real andimaginary components of both voltage and current. These signals areprocessed by an field-programmable gate array (FPGA) to give differentmeasurements relating to voltage and current, including the RMSmeasurements of the AC signals, phase shift between voltage and current,and power. Accordingly, in one embodiment, the output voltage andcurrent are measured in analog, converted to digital, processed by anFPGA to calculate RMS voltage and current, apparent power and phaseangle between voltage and current, and then are converted back to analogfor the controller.

For each device port there are a pair of signals for voltage and a pairof signals for current that originate from the RF amplifier 142. In oneembodiment, the generator has two redundant RF sense circuits 143 a, 143b that measures voltage and current for each device at differentlocations on the RF amplifier. The first RF Sense circuit senses currentby sense resistors delivered through a connected electrosurgicalinstrument on either device port 1 or device port 2, and the voltagemeasured across return to output on either device port 1 or device port2. The second RF Sense circuit senses current by sense resistors,returned from a connected electrosurgical instrument on either deviceport 1 or device port 2, and the voltage 146 a, 146 b measured acrossoutput to return on either device port 1 or device port 2. The voltageinput signals are high voltage sinusoidal waveforms at 350 kHz that areattenuated and AC coupled by a voltage divider and an inverting filterto remove DC bias on the signals. An inverting filter is used as thevoltage and current inputs are 180 degrees out of phase as they aremeasured at opposite polarities. For each voltage input signal, twoseparate inverted and non-inverted voltage sense signals are generated.In one embodiment, a differential voltage measurement is made betweenthe current input signals to generate two separate pairs of inverted andnon-inverted current sense signals. The current input signals representvoltage across a shunt resistor on the RF Amplifier in which thisvoltage is proportional to the current flowing through the shuntresistor. The current input signals are low voltage sinusoidal waveformsat 350 kHz that are amplified using a non-inverting filter to remove DCbias on the signals. The RF Sense generates a signal that is analogousto multiplying each voltage and current signal by predeterminedreference signals. As such, the RF Sense provides the non-invertedvoltage and current sense signals when the waveform is positive, theinverted voltage and current sense signals when the waveform isnegative, and a ground signal when the waveform is zero.

The RF sense in accordance with various embodiments receives fourreference synchronization signals supplied by the controller via the RFamplifier. The synchronization signals are 350 kHz pulse signals withthe same duty cycle but with differing phase shifts and in oneembodiment are 90 degrees phase shifted from each other. Two of thesynchronization signals are used to generate the in-phase waveforms togenerate the real component of the input waveforms and the two othersynchronization signals are used to generate the quadrature waveforms togenerate the imaginary components of the input waveforms. These signalsare processed further to generate control signals to a plurality ofswitches. The outputs of the switches are tied together to generate asingle output. In one embodiment, the control signals to the switchesdetermine which input signal passes through to the single output. Inaccordance with various embodiments, a first combination allowsnon-inverted voltage and current sense signals to pass through whichrepresents or is analogous to multiplying these sense signals by apositive pulse. A second combination allows the inverted voltage andcurrent sense signals to pass through which represents or is analogousto multiplying these sense signals by a negative pulse. A thirdcombination allows the ground signal to pass through generating a zerovoltage output which represents or is analogous to multiplying the sensesignals by zero. Each output is supplied to a low pass filter thatgenerates a DC voltage corresponding to the real or imaginary componentof the sensed signals. These signals are supplied to ADCs which sends adigital signal to the FPGA.

In one embodiment, Controller 144 controls the RF amplifier 142 toaffect the output RF energy. For example, Controller utilizes theinformation provided by the RF sense 143 to determine if RF energyshould be outputted and when to terminate the output of RF energy. Inone embodiment, the controller compares a predetermined phase thresholdbased on a particular tissue in contact with the connectedelectrosurgical device 20 to determine when to terminate the output ofRF energy. In various embodiments, the controller performs a fusionprocess described in greater detail below and in some embodiments thecontroller receives the instructions and settings or script data toperform the fusion process from data transmitted from theelectrosurgical instrument.

In accordance with various embodiments as shown in FIG. 17, thegenerator has six major sub-systems or modules of circuitry that includeSystem Power or Power Supply 145, Controller 144, Front Panel Interface146, Advanced Bipolar Device Interface 147, RF Amplifier 142 and RFSense 143. In accordance with various embodiments, one or more of thecircuitry may be combined or incorporated with other circuitry. Thepower supply 145 is configured to provide DC voltages to all the othercircuitry or sub-systems along with control signals to control the powersupply outputs. The power supply receives AC power input that is 90-264VAC, 47-63 Hz and in one embodiment the power supply has a switch,integrated or separate, that is configured to connect or disconnect theAC power input from the generator. The controller through the FrontPanel Interface (FPI) and Advanced Bipolar Device Interface (ABDI)supports the user interface 121 and instrument connections forelectrosurgical devices 1 and 2 connected to the electrosurgicalgenerator.

The RF Amplifier 142 generates high power RF energy to be passed througha connected electrosurgical instrument and in one example, anelectrosurgical instrument for fusing of tissue. The RF Amplifier inaccordance with various embodiments is configured to convert a 100 VDCpower source to a high power sinusoidal waveform with a frequency of 350kHz which is delivered through the ABDI 147 and eventually the connectedelectrosurgical device. The RF Sense 143 interprets the measured ACvoltage and current from the RF amplifier 42 and generates DC controlsignals, including voltage, current, power, and phase, that isinterpreted by Controller 144.

The generator has a plurality of specialized connection receptacles, inthe illustrated embodiment device port 1 and device port 2, that areused only for connecting to advanced bipolar devices, such as anadvanced bipolar electrosurgical instrument. The specialized receptacleseach include an array spring-loaded probes or pogo pins. The generatorin various embodiments includes a circuit to detect the presence of anadvanced bipolar device prior to energizing any active output terminalsat the receptacles.

The Front Panel Interface (FPI) 146 is configured to drive a display,device signals from the controllers and LED backlights for front panelbuttons. The FPI is also configured to provide power isolation throughregulators and provide functionality for the front panelswitches/buttons. In one embodiment, the ABDI 147 is used as apass-through connection which provides a connection to the devicesthrough the FPI. The FPI also provides connection between Controller 144and a connected electrosurgical device through the ABDI. The deviceinterface in one embodiment is electrically isolated from the rest ofthe FPI. The interface in various embodiments includes lines that readand write to an ferromagnetic random access memory (FRAM) on an advancedbipolar device, read a trigger switch and/or read a signal thatindicates a device is connected. In one embodiment, a device memorycircuit is provided that utilizes the controller's serial peripheralinterface (SPI) to read and write the FRAM of the advanced bipolardevice. In one embodiment, the FRAM is replaced with a microcontrollerand the interface includes an interrupt line so all information passedthrough a digital interface between the electrosurgical device and thegenerator. FPI provides isolation for SPI signals to and from advancedbipolar device through ABDI. In one embodiment, the SPI interface isshared between two advanced bipolar devices with port pins being used aschip selects.

In accordance with various embodiments, the generator includes a SPIcommunication bus that allows the controller to have bi-directionalcommunication with complex programmable logic devices (CPLDs) and the RFSense FPGAs. In various embodiments, the FPI provides SPI interfacebetween the controller and connected devices through an ABDI connectorto communicate with the FRAM on the advanced bipolar devices. FPI alsoprovides electrical isolation for low voltage signals from betweencontroller and the ABDI. The device interface on the ABDI is configuredto transmit RF energy to the connected device along with SPIcommunication. In one embodiment, the ABDI connects a signal from adevice that indicates it is connected.

The FPI-ABDI interface provides power to the devices that connect to thegenerator, SPI communication between controller and the devices, deviceswitch signals from the devices to the controller, and device connectedsignals from the devices to the controller. ABDI provides the RF energyto each connected advanced bipolar device through a separate pogo pinarray. The FPI provides signal, low voltage power and high voltage RFpower from the FPI and RF Amplifier to the connected device through theABDI connector via the pogo pin array.

In accordance with various embodiments, an operations engine enables thegenerator to be configurable to accommodate different operationalscenarios including but not limited to different and numerouselectrosurgical tools, surgical procedures and preferences. Theoperations engine receives and interprets data from an external sourceto specifically configure operation of the generator based on thereceived data.

The operations engine receives configuration data from a database scriptfile that is read from a memory device on a device plug. The scriptdefines the state logic used by the generator. Based on the statedetermined and measurements made by the generator, the script can defineor set output levels as well as shutoff criteria. The script in oneembodiment includes trigger events that include indications of shortcondition for example when a measured phase is greater than 70 degreesor an open condition for example when a measured phase is less than −50degrees.

In one embodiment, the operations engine provides system states and userstates. System states are predefined or predetermined states thatcontrol or manage specific predefined or predetermined operations of thegenerator, such as successfully applying RF energy or indicating anerror. System states in one embodiment are a pre-defined set ofconfiguration that the system can be in (e.g., idle vs. energized) andwhose functions are hard-coded into the electrosurgical generator. Forexample, a RF Done state is a system state that indicates that an RFenergy cycle has been completed without errors. User states provide aframework through which customized or specialized operations and valuescan be established by direction from an external source for a particulartool, procedure and/or preference.

In one embodiment, the script sets forth the system states and theirexit conditions, e.g., expiration times or pointers or directions toanother state and where the user states begin. For each user state,operation parameters for the specific state can be defined such aspower, voltage, and current settings or are carried over from a previousstate. In one embodiment, the user states may provide device, operatoror procedural specific states and in one embodiment, the user states maybe provided for testing or diagnostics specific states.

Referring to FIG. 18, the generator 10 receives script information fromthe electrosurgical device or instrument 20 when the device isconnected. The generator uses this script information to define a numberof states and the order of execution of the states.

The script source file or script information 180 written by the devicescript author and not resident on the instrument or the generator 10 istext or user readable. The script information is compiled using a scriptcomplier 185 to generate a device script database or binary file (SDB)101. The script binary file is transferred by a device key programmer187 to a memory module that is connectable or incorporated into theelectrosurgical instrument 20 via a device key 182. As theelectrosurgical instrument is connected to the electrosurgicalgenerator, the generator authenticates the script binary file and/or theinstrument (188). The generator validates the script binary file (189)and if validated the operations engine utilizes the script initiated bythe actuation by the connected instrument (190). Script source file inone embodiment is a text file containing a device script that isspecific for a specific electrosurgical instrument, generator and/orsurgical procedure. The script source file for a device in oneembodiment includes information containing parameters and a script(states, functions, events) for the electrosurgical generator and/orelectrosurgical instrument. After successful validation, the scriptcompiler assembles data into a binary format that defines a statemachine for use by the electrosurgical generator. Script compiler asshown in FIG. 18 in one embodiment is separate from the electrosurgicalgenerator and is responsible for reading in text from the script sourcefile and validating its contents.

When the memory module is inserted into the generator, the generatordownloads a binary file that is stored in a ferromagnetic random accessmemory (FRAM) or microcontroller disposed within the module. The binaryincludes logic for implementing the treatment algorithms or processes inaccordance with various embodiments. The generator in variousembodiments includes firmware/software, hardware or combinations thereofresponsible for processing the binary to authentic the connectedinstrument and to execute the binary for performing the treatmentalgorithm. In this manner, the generator is configured to operate onlywith authenticated, compatible hand tools.

In one embodiment, instrument scripts or script database represent aninstrument process for a specific or given instrument. The instrumentscripts are stored on memory connected to or integrated with aninstrument, the controller or a combination thereof. The event handlerresponds to specific events, such as a switch activation/de-activation,instrument positions or exceeding measurement thresholds. The operationsengine based on the detected event if appropriate for a given eventprovides output to the connected instrument. In one embodiment, an eventis a discrete change, as in a switch is asserted or de-asserted.

Script state is a block or set of script functions or operationconditions and script events or indicators. Script functions areconfigurable instructions for controlling the generator and/or theinstruments. Script operators are logical and comparison operationsperformed during a script event evaluation. Script parameters areconfiguration data used by all states and events of a script and in oneembodiment are declared in their own dedicated section of the scriptfile. Script events are a discrete change in an electrosurgicalgenerator measurement. When a Script Event occurs, for example, asequence of script functions is executed.

In accordance with various embodiments, phase angle between voltage andcurrent and/or the change or phase angle rate is utilized to maximizethe amount of time the tissue is in a predetermined temperature range.In one embodiment, the predetermined temperature range is between 60degrees C. to 100 degrees C. In one embodiment, low voltage is utilizedto minimize temperature effects while accelerating sealing or fusingtime.

In accordance with various embodiments, tissue is grasped between jawsof the bipolar electrosurgical device. The bipolar electrosurgicaldevice removably connected to an electrosurgical generator is suppliedRF energy that upon command is supplied to the tissue. The supplied RFenergy has a predetermined voltage range that heats the tissue at apredetermined rate. In one embodiment, the predetermined voltage rangeis between 20 Vrms to 50 Vrms. During the application of RF energy, thephase angle between output voltage and current are monitored to identifyphase increases or decreases. Initially, phase angle is monitored todetermine a change in phase angle or rate from increasing to decreasing.It is contemplated that once this point of inflection has occurred, itis determined that water in the jaws of the device has reached 100degrees C. and the temperature to cause the required tissue affect hasbeen exceeded. A shutoff point is then determined to terminate thesupply of RF energy.

Exemplary RF energy control process for the electrosurgical generatorand associated electrosurgical tool for fusing tissue in accordance withvarious embodiments are shown in FIGS. 19-21. In various embodiments, asillustrated in FIG. 19, RF energy is supplied by the generator throughthe connected electrosurgical tool (251). The generator monitors atleast the phase and/or change/rate of phase of the supplied RF energy(252). If a phase/phase change is greater than zero or trending positive(253), voltage is increased (254). The generator continues to monitor atleast the phase and/or change/rate of phase of the supplied RF energy(255). If the phase/phase change continues to increase (256), thegenerator continues to monitor the phase and/or change of phase. If thephase/phase change decreases (257), the process is done or terminationprocedures are initiated and/or RF energy supplied by the generator isstopped (258).

In one embodiment, prior to the start of the process, impedance ismeasured to determine a short or open condition through a low voltagemeasurement signal delivered to a connected electrosurgical tool. In oneembodiment, passive impedance is measured to determine if the tissuegrasped is within the operating range of the electrosurgical tool(2-200Ω). If the initial impedance check is passed, RF energy issupplied to the electrosurgical tool. After which impedance/resistanceis not measured or ignored.

Initially, initial parameters are set to prepare for sealing of tissuegrasped between the jaws. In one embodiment, voltage and currentsettings are set to a specific setting. In one embodiment, voltage ofthe RF energy is applied in a ramping fashion starting from 30% of aglobal setting or user selected level (e.g., 27.5-88V for level 1,25.0-80V for level 2 and 22.5V-72V for level 3). The voltage DAC is setto 30% of the voltage setting which on level 2 (medium) is 25.5 Vrms.The phase is monitored to determine a phase angle above zero degrees andto heat the tissue and water between the jaws of the electrosurgicaldevice at a predetermined slow rate.

Referring now to FIGS. 20-21, in various embodiments, RF energy issupplied by the generator through the connected electrosurgical tool(251). The generator monitors at least the phase and/or change/rate ofphase of the supplied RF energy (252). If a phase/phase change isgreater than zero or trending positive (253), voltage is increased(254). In various embodiments, voltage is increased at a predeterminedrate, for example, 50% over 5 seconds, which is 42.5 Vrms on level 2(medium) after the phase has increased to be greater than zero degrees.The ramping continues until a predetermined condition is met. In oneembodiment, the ramping continues as the monitored phase angle increasesto above five degrees. This ensures that phase is increasing as expectedbased on heating of the tissue.

In a next subsequent state (265), if the monitored phase angle increasesabove a predetermined phase value, e.g., 5 degrees, phase continues tobe monitored for an increasing state or condition. This is contemplatedthat such an increasing condition is an indication that the temperatureof the tissue and water between the jaws is increasing but less than 100degrees C. However, the monitored phase indicating a decreasing state orcondition provides a different indication. It is contemplated that suchan indication is that the temperature of the tissue and water betweenthe jaws has reached at least 100 degrees C. and/or the desired tissueaffect has been completed, e.g., sealing and/or cutting of the tissue.

In one or more subsequent states, the monitored phase angle is checkedfor an increasing or decreasing condition. In accordance with variousembodiments, various incremental or periodic checks are performed alongwith various incremental or periodic updates to various predeterminedthresholds or indications to determine an increasing phase angle orrates of change condition or a decreasing phase angle or rates of changecondition.

When one or more of the subsequent states determines that the phaseangle, rate or trend of the phase angle is decreasing rather thanincreasing, the indication is that the desired tissue affect has beencompleted, e.g., sealing and/or cutting of the tissue. As such, it iscontemplated that in such an indication the temperature of the tissueand water between the jaws has reached at least 100 degrees C.

At such a state or in a subsequent state, voltage ramping or increasingof the output RF energy is ramped down or decreased. As such, the rapidboiling of water is reduced or prevented and temperature is held steadyor constant until a predetermined condition is reached. In oneembodiment, the predetermined condition is the phase angle dropping toat least 5 degrees.

In accordance with various embodiments, in a next subsequent state(266), if the monitored phase angle increases above a predeterminedphase value, e.g., 10 degrees, phase continues to be monitored for anincreasing state or condition. If however the monitored phase angleinstead indicates a decreasing state, e.g., decreases below apredetermined phase value, e.g., five degrees (268) or a predeterminedtime limit has been reached, voltage increase is stopped (280).Subsequently, if the monitored phase angle continues to indicate adecreasing state, e.g., decreases below a predetermined phase value,e.g., five degrees (268) or if a predetermined time limit has beenreached, RF energy is stopped and the process ends (281).

If the monitored phase angle indicates an increasing state, e.g., in anext subsequent state (267), if the monitored phase angle increasesabove a predetermined phase value, e.g., 12.5 degrees, phase continuesto be monitored for a continued increasing state or condition. If themonitored phase angle instead now indicates a decreasing state, e.g.,decreases below a predetermined phase value, e.g., 7.5 degrees (269) ora predetermined time limit has been reached, voltage increase is stopped(280). Subsequently, if the monitored phase angle continues to indicatea decreasing state, e.g., decreases below a predetermined phase value,e.g., five degrees (268) or if a predetermined time limit has beenreached, RF energy is stopped and the process ends (281).

In a next subsequent state (270), if the monitored phase angle indicatesan increasing state, e.g., increases above a predetermined phase value,e.g., 15 degrees, voltage increase is stopped (271) and phase continuesto be monitored for an increasing state or condition. If however themonitored phase angle instead indicates a decreasing state, e.g.,decreases below a predetermined phase value, e.g., ten degrees (277) ora predetermined time limit has been reached, voltage increase is stopped(280). Subsequently, if the monitored phase angle continues to indicatea decreasing state, e.g., decreases below a predetermined phase value,e.g., five degrees (282) or if a predetermined time limit has beenreached, RF energy is stopped and the process ends (281). In a nextsubsequent state (272), if the monitored phase angle indicates anincreasing state, e.g., increases above a predetermined phase value,e.g., 20 degrees, phase continues to be monitored for an increasingstate or condition. If the monitored phase angle instead indicates andecreasing state, e.g., decreases below a predetermined phase value,e.g., ten degrees (277) or a predetermined time limit has been reached,phase continues to be monitored for a decreasing state or condition.Subsequently, if the monitored phase angle decreases below apredetermined phase value, e.g., five degrees (282) or if apredetermined time limit has been reached, RF energy is stopped and theprocess ends (281).

In a next subsequent state (273), if the monitored phase angle continuesto indicate an increasing state, e.g., increases above a predeterminedphase value, e.g., 25 degrees, phase continues to be monitored for anincreasing state or condition. If the monitored phase angle decreasesinstead below a predetermined phase value, e.g., fifteen degrees (278)or a predetermined time limit has been reached, phase continues to bemonitored for a decreasing state or condition. Subsequently, if themonitored phase angle decreases below a predetermined phase value, e.g.,five degrees (282) or if a predetermined time limit has been reached, RFenergy is stopped and the process ends (281). In a next subsequent state(274), if the monitored phase angle increases above a predeterminedphase value, e.g., 30 degrees, phase continues to be monitored for anincreasing state or condition. If the monitored phase angle insteaddecreases below a predetermined phase value, e.g., fifteen degrees (278)or a predetermined time limit has been reached, phase continues to bemonitored for a decreasing state or condition. Subsequently, if themonitored phase angle decreases below a predetermined phase value, e.g.,five degrees (285) or if a predetermined time limit has been reached, RFenergy is stopped and the process ends (281).

In a next subsequent state (275), if the monitored phase angle increasesabove a predetermined phase value, e.g., 35 degrees, phase continues tobe monitored for an increasing state or condition. However, if themonitored phase angle instead decreases below a predetermined phasevalue, e.g., fifteen degrees (278) or a predetermined time limit hasbeen reached, phase continues to be monitored for a decreasing state orcondition. Subsequently, if the monitored phase angle decreases belowfive degrees (282) or if a predetermined time limit has been reached, RFenergy is stopped and the process ends (281). In a next subsequent state(276), if the monitored phase angle increases above a predeterminedphase value, e.g., 40 degrees, phase is monitored for a decreasingcondition and if the monitored phase angle decreases below apredetermined phase value, e.g., fifteen degrees (278) or apredetermined time limit has been reached, phase continues to bemonitored for a decreasing state or condition. Subsequently, if themonitored phase angle decreases below a predetermined phase value, e.g.,five degrees (282) or if a predetermined time limit has been reached, RFenergy is stopped and the process ends (281). It is contemplated andnoted that, for the exemplary and operational seal/fuse andcut/dissection process or system provided above and throughout theapplication, the frequency of incremental checks and/or the indicationsof increasing or decreasing states, e.g., predetermined angles or ratesof change, can vary to provide different and various levels andgranularity of regulation or control as desired or required based on thespecific electrosurgical instrument, generator, tissue and/or surgicalprocedure.

FIGS. 22-24 are graphical representations of exemplary vesselsealing/fusing utilizing systems and processes in accordance withvarious embodiments of the present invention. As shown, the success rate223 of providing a tissue seal above 3× systolic burst pressure are highand time 223 for sealing of vessels up to 4 mm in size was small, e.g.,less than 2 seconds. The times for sealing vessels between 4-7 mm wasalso reduced, e.g., less than 5 seconds. The time for the phase angle todecrease from the maximum to a predetermined phase value, e.g., 5degrees, is longer than those up to 4 mm. Such changes or reduction insealing time while also providing successful vessel seals, e.g.,withstanding above 3× systolic burst pressure, in accordance withvarious embodiments is refined by identifying and/or triggering at thepoint of inflection of the derivate of the phase trend and incorporatedinto incremental checks, state indicators or thresholds. In variousembodiments, the point of inflection of the derivate of the phase trendis identified at the point where the phase trend changes from anincreasing state to a decreasing state.

As shown in FIG. 23, the vessel was 6.62 mm in diameter and wassuccessfully sealed, e.g., having a burst pressure of 12.7 psi.Additionally, as shown, the phase angle 230 g increases as RF energy isapplied. The rate of the increase is not rapid but rather sufficientlyslow as well as the temperature 230 d of the tissue. The point ofinflection 231, e.g., the point at which phase changes from increasingto decreasing occurs approximately 1.5 seconds before RF energy isstopped. As shown in FIG. 24, the vessel was 1.89 mm in diameter and wassuccessfully sealed, e.g., having a burst pressure of 13 psi. Theoverall trend of phase angle 240 g and temperature 240 d is similar aswith the previous vessel seal, although the time scale shown in FIG. 24is approximately ¼ of that of FIG. 23. Also, as illustrated, phase 230g, 240 g are shown relative to other tissue readings or indicators suchas voltage 230 a, 240 a; power 230 b, 240 b; impedance 230 e, 240 e;energy 230 c, 240 c; temperature 230 d, 240 d; and current 230 f, 240 f.Additionally, although shown in FIGS. 23-24, in various embodiments, thegenerator is configured to not measure or calculate one or more of theindicators or readings, e.g., temperature or energy, to reduceoperational and power costs and consumptions and the number of parts forthe generator. The additional information or readings are generallyprovided or shown for context purposes.

It is noted that the impedance of the tissue is near its minimum for theentire seal cycle. As such, this provides a low voltage and high currentand thus consistent power delivery throughout the seal cycle. Efficientor consistent power delivery reduces thermal spread. In accordance withvarious embodiments, the time for sealing can be decreased, reduction involtage output to below 50 Vrms and/or reduction of power output tobelow 50 Watts. To avoid false readings, in accordance with variousembodiments, the electrosurgical generator does not measure resistanceor impedance of the tissue during the supply of RF energy to the tissue.

In accordance with various embodiments, an electrosurgical system isprovided that decreases thermal spread, provides lower output levels andefficient power delivery for sealing vessels or tissue in contact with abipolar electrosurgical instrument through the controlled and efficientsupply of RF energy.

As described throughout the application, the electrosurgical generatorultimately supplies RF energy to a connected electrosurgical instrument.The electrosurgical generator ensures that the supplied RF energy doesnot exceed specified parameters and detects faults or error conditions.In various embodiments, an electrosurgical instrument provides thecommands or logic used to appropriately apply RF energy for a surgicalprocedure. An electrosurgical instrument for example includes memoryhaving commands and parameters that dictate the operation of theinstrument in conjunction with the electrosurgical generator. Forexample, in a simple case, the generator can supply the RF energy butthe connected instrument decides how much or how long energy is applied.The generator however does not allow the supply of RF energy to exceed aset threshold even if directed to by the connected instrument therebyproviding a check or assurance against a faulty instrument command.

Turning now to some of the operational aspects of the electrosurgicaltool or instrument described herein in accordance with variousembodiments, once a vessel or tissue bundle has been identified forfusing, dissecting or both, the first and second jaws are placed aroundthe tissue. The movable handle 23 is squeezed moving the movable handleproximally with respect to the stationary housing 28. As the movablehandle moves proximally the first jaw pivots towards the second jaweffectively clamping the tissue. Radio frequency energy is applied tothe tissue by depressing the activation button on the stationary handle.Once the tissue has been fused, dissected or both, the movable handle isre-opened.

Alternatively or additionally, with the jaws in a fully open position orin an intermediate position between a fully open position and theengaged position, radio frequency energy can applied to the tissue incontact with a lower surface or portion of the lower jaw by depressingthe activation button or a separate activation button to fuse and/ordissect tissue.

As described generally above and described in further detail below,various electrosurgical instruments, tools or devices can be used in theelectrosurgical systems described herein. For example, electrosurgicalgraspers, scissors, tweezers, probes, needles, and other instrumentsincorporating one, some, or all of the aspects discussed herein canprovide various advantages in an electrosurgical system. Variouselectrosurgical instruments and generator embodiments and combinationsthereof are discussed throughout the application. It is contemplatedthat one, some, or all of the features discussed generally throughoutthe application can be included in any of the embodiments of theinstruments, generators and combinations thereof discussed herein. Forexample, it can be desirable that each of the instruments describedinclude a memory for interaction with the generator as previouslydescribed and vice versa. However, in other embodiments, the instrumentsand/or generators described can be configured to interact with astandard bipolar radio frequency power source without interaction of aninstrument memory. Further, although various embodiments may bedescribed in terms of modules and/or blocks to facilitate description,such modules and/or blocks may be implemented by one or more hardwarecomponents, e.g., processors, Digital Signal Processors (DSPs),Programmable Logic Devices (PLDs), Application Specific IntegratedCircuits (ASICs), circuits, registers and/or software components, e.g.,programs, subroutines, logic and/or combinations of hardware andsoftware components. Likewise, such software components may beinterchanged with hardware components or a combination thereof and viceversa.

Further examples of the electrosurgical unit, instruments andconnections there between and operations and/or functionalities thereofare described in U.S. patent application Ser. No. 12/416,668, filed Apr.1, 2009, entitled “Electrosurgical System”; Ser. No. 12/416,751, filedApr. 1, 2009, entitled “Electrosurgical System”; Ser. No. 12/416,695,filed Apr. 1, 2009, entitled “Electrosurgical System”; Ser. No.12/416,765, filed Apr. 1, 2009, entitled “Electrosurgical System”; andSer. No. 12/416,128, filed Mar. 31, 2009, entitled “ElectrosurgicalSystem”; the entire disclosures of which are hereby incorporated byreference as if set in full herein. Certain aspects of theseelectrosurgical generators, tools and systems are discussed herein, andadditional details and examples with respect to various embodiments aredescribed in US Provisional Application Nos. 61/994,215, filed May 16,2014, entitled “Electrosurgical Fusion Device”; 61/944,185, filed May16, 2014, “Electrosurgical Generator with Synchronous Detector”;61/994,415, filed May 16, 2014, “Electrosurgical System”; and61/944,192, filed May 16, 2014, entitled “Electrosurgical Generator”,the entire disclosures of which are hereby incorporated by reference asif set in full herein.

The above description is provided to enable any person skilled in theart to make and use the surgical instruments and perform the methodsdescribed herein and sets forth the best modes contemplated by theinventors of carrying out their inventions. Various modifications,however, will remain apparent to those skilled in the art. It iscontemplated that these modifications are within the scope of thepresent disclosure. Additionally, different embodiments or aspects ofsuch embodiments may be shown in various figures and describedthroughout the specification. However, it should be noted that althoughshown or described separately each embodiment and aspects thereof may becombined with one or more of the other embodiments and aspects thereofunless expressly stated otherwise. It is merely for easing readabilityof the specification that each combination is not expressly set forth.Also, embodiments of the present invention should be considered in allrespects as illustrative and not restrictive.

1. An electrosurgical system comprising: an electrosurgical instrumentcomprising: a first jaw comprising a first electrode; and a second jawopposing the first jaw and comprising a second electrode, the first andsecond jaws pivotably arranged to grasp tissue between the first andsecond jaws and the first and second electrodes of the first and secondjaws being arranged to transmit radio frequency energy (RF) between thefirst and second electrodes; an electrosurgical generator arranged tosupply the radio frequency (RF) energy, the electrosurgical generatorcomprising a controller arranged to periodically monitor a phase angleof the supplied RF energy and configured to signal an RF amplifier toincrease voltage of the supplied RF energy when the monitored phaseangle is greater than zero and increasing.
 2. The electrosurgical systemof claim 1 wherein the controller continues to signal the RF amplifierto increase voltage of the RF energy when the monitored phase anglecontinues to exceed a predetermined threshold angle and the RF amplifierincreases voltage of the supplied RF energy at a predetermined constantrate.
 3. The electrosurgical system of claim 2 wherein the controller isconfigured to signal the RF amplifier to halt the supplied RF energywhen the monitored phase angle decreases.
 4. The electrosurgical systemof claim 2 wherein the controller periodically monitors a rate of changeof the phase angle of the supplied RF energy and the controller signalsthe RF amplifier to halt the supplied RF energy when the rate of changeof the phase angle falls below a predetermined threshold rate.
 5. Theelectrosurgical system of claim 1 wherein the RF amplifier increasesvoltage of the supplied RF energy at a predetermined constant rate andthe controller signals the RF amplifier to halt the voltage increase ofthe supplied RF energy when the monitored phase angle exceeds apredetermined threshold angle while the RF amplifier continues to supplyRF energy.
 6. The electrosurgical system of claim 5 further comprisingRF sense circuitry arranged to measure voltage and current of thesupplied RF energy by using analog circuitry, the measured voltage andcurrent used to calculate the monitored phase angle monitored.
 7. Theelectrosurgical system of claim 1 wherein the first jaw furthercomprises a third electrode and the second jaw further comprises afourth electrode.
 8. The electrosurgical system of claim 7 wherein thefirst and second electrodes are arranged to fuse the tissue between thefirst and second jaws using radio frequency energy on one side of alongitudinal axis and the third and fourth electrodes are arranged tofuse the tissue between the first and second jaws using radio frequencyenergy on an opposing side of the longitudinal axis.
 9. Theelectrosurgical system of claim 8 wherein the second electrode protrudesup towards the first jaw to a first inner flat portion of the secondelectrode and the fourth electrode protrudes up towards the first jaw toa second inner flat portion of the fourth electrode adjacent to thefirst inner flat portion of the second electrode.
 10. Theelectrosurgical system of claim 9 wherein the second jaw furthercomprises a fifth electrode extending away from the first jaw and thesecond jaw.
 11. The electrosurgical system of claim 10 wherein the fifthelectrode is arranged to cut the tissue outside the second jaw throughradio frequency energy being conducted between the fifth electrode andthe second and fourth electrodes.
 12. The electrosurgical system ofclaim 7 wherein the first electrode is arranged to have a first polarityand the second electrode is arranged to have a second polarity, thesecond polarity being different from the first polarity of the firstelectrode.
 13. The electrosurgical system of claim 12 wherein the fourthelectrode is arranged to have the first polarity and the third electrodeis arranged to have the second polarity and wherein the first, second,third and fourth electrodes electrically interact together to fuse andcut the tissue between the first and second jaws.
 14. Theelectrosurgical system of claim 7 wherein the second electrode has aflat portion and the fourth electrode has a flat portion.
 15. Theelectrosurgical system of claim 14 wherein the first electrode has anangled surface and the third electrode has an angled surface.
 16. Theelectrosurgical system of claim 7 wherein the second electrode protrudesup towards the first jaw to a first inner flat portion of the secondelectrode and the fourth electrode protrudes up towards the first jaw toa second inner flat portion of the fourth electrode adjacent to thefirst inner flat portion of the second electrode.
 17. Theelectrosurgical system of claim 16 wherein the second jaw furthercomprises a fifth electrode extending away from the first jaw and thesecond jaw.
 18. The electrosurgical system of claim 17 wherein the fifthelectrode is arranged to cut the tissue outside the second jaw throughradio frequency energy being conducted between the fifth electrode andthe second and fourth electrodes.